wynonna
True Blue
So many visits by our new provider in seeing established patients are level 4 History, level 4 Exam, and Level 3 MDM, so I have to address this. (borderline level 3/4)
I understand medical necessity is usually determined by the provider since coders lack the clinical piece. I also understand MDM carries the most weight over History and Exam sections. Also, medical necessity is the overarching theme for the visit, beginning with the chief complaint--reason for the visit-- and HPI and going through the exam and MDM. I just want to present both sides if I decide to go to the practice manager about this (AAPC side and our new providers side). Our new provider has been coding and seeing patients for 6 years at another practice.
I know this new provider is NOT copy/pasting from one note to another from prior visits in our practice and she is NOT having staff fill in blanks on EMR or NOR using prepopulated sections. I have gone through several weeks of her notes and her HPI and ROS are different for each patient. The ROS relates directly to chief complaint in each section. The exam is based also on reason for visit. Each of the 3 sections are described in relation to the individual patient and their chronic and acute problems.
The new provider in question is seeing patients who were being treated by 2 other of our providers, who just retired. So every condition is new to this new provider/examiner so she spends more time with her patients (new to her, but established to the practice)
So if she is gathering extra info on each patient because she is unfamiliar with their case and needs background info to treat them, does this constitute medical necessity?
In other words, which level would be billed when: History is detailed (level 4), Exam is detailed (level 4) and patient has 2 or 3 diagnoses/symptoms and Rx are NOT given?
Any advice on how to approach this subject with new provider or practice manager is appreciated.. I work at home remotely, so my correspondence is usually via email. Thank you for any assistance you may have. I welcome any viewpoint.
I understand medical necessity is usually determined by the provider since coders lack the clinical piece. I also understand MDM carries the most weight over History and Exam sections. Also, medical necessity is the overarching theme for the visit, beginning with the chief complaint--reason for the visit-- and HPI and going through the exam and MDM. I just want to present both sides if I decide to go to the practice manager about this (AAPC side and our new providers side). Our new provider has been coding and seeing patients for 6 years at another practice.
I know this new provider is NOT copy/pasting from one note to another from prior visits in our practice and she is NOT having staff fill in blanks on EMR or NOR using prepopulated sections. I have gone through several weeks of her notes and her HPI and ROS are different for each patient. The ROS relates directly to chief complaint in each section. The exam is based also on reason for visit. Each of the 3 sections are described in relation to the individual patient and their chronic and acute problems.
The new provider in question is seeing patients who were being treated by 2 other of our providers, who just retired. So every condition is new to this new provider/examiner so she spends more time with her patients (new to her, but established to the practice)
So if she is gathering extra info on each patient because she is unfamiliar with their case and needs background info to treat them, does this constitute medical necessity?
In other words, which level would be billed when: History is detailed (level 4), Exam is detailed (level 4) and patient has 2 or 3 diagnoses/symptoms and Rx are NOT given?
Any advice on how to approach this subject with new provider or practice manager is appreciated.. I work at home remotely, so my correspondence is usually via email. Thank you for any assistance you may have. I welcome any viewpoint.